Applying an equity lens to liver health and research in Europe

Ventura‐Cots, Meritxell; Bataller, R.; Lazarus, Jeffrey V.; Benach, Joan; Pericàs, Juan M.

doi:10.1016/j.jhep.2022.07.021

Cited by 9 publications

(13 citation statements)

References 45 publications

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“…Our results align well with prior studies in the USA and Europe where the low cost of diagnosis and treatment of MASLD have been reported on population samples [ 15 , 16 ]. The prevalence of MASLD reported in a previous study based on the CONSTANCES cohort after adjustment to ensure full representativeness of the French adult population was 18.2%, lower than the 25% worldwide estimate [ 5 ].…”

Section: Discussionsupporting

confidence: 92%

“…The total healthcare costs estimated at 15.7 billion € by our study also come close to the estimated 11.4 € billion in the model-based study of MASLD costs by Younoussi with 2015 cost data [ 6 ]. Regarding estimates for the MASH population, our results align well with prior studies in the USA and Europe where the low costs of diagnosis and treatment have been reported on population samples [ 15 , 16 ]. We found a pattern of resource utilization of general practitioners and specialists consistent with the results of the National Health and Wellness Survey, albeit lower as can be expected for MASLD vs MASH patients [ 17 ].…”

Section: Discussionsupporting

confidence: 90%

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Factors associated with high costs of patients with metabolic dysfunction-associated steatotic liver disease: an observational study using the French CONSTANCES cohort

Ossima,

Brzustowski,

Paradis

et al. 2024

Clin Diabetes Endocrinol

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Background & aims Despite its high prevalence in the western world metabolic dysfunction-associated steatotic liver disease (MASLD) does not benefit from targeted pharmacological therapy. We measured healthcare utilisation and identified factors associated with high-cost MASLD patients in France. Methods The prevalent population with MASLD (including non-alcoholic steatohepatitis) in the CONSTANCES cohort, a nationally representative sample of 200,000 adults aged between 18 and 69, was linked to the French centralised national claims database (SNDS). Study participants were identified by the fatty liver index (FLI) over the period 2015–2019. MASLD individuals were classified according as “high-cost” (above 90th percentile) or “non-high cost” (below 90th percentile). Factors significantly associated with high costs were identified using a multivariate logistic regression model. Results A total of 14,437 predominantly male (69%) participants with an average age of 53 ± SD 12 years were included. They mainly belonged to socially deprived population groups with co-morbidities such as diabetes, high blood pressure, mental health disorders and cardiovascular complications. The average expenditure was €1860 ± SD 4634 per year. High-cost MASLD cost €10,863 ± SD 10,859 per year. Conditions associated with high-cost were mental health disorders OR 1.79 (1.44–2.22), cardiovascular diseases OR 1.54 (1.21–1.95), metabolic comorbidities OR 1.50 (1.25–1.81), and respiratory disease OR 1.50 (1.11–2.00). The 10% high-cost participants accounted for 58% of the total national health care expenditures for MASLD. Conclusion Our results emphasize the need for comprehensive management of the comorbid conditions which were the major cost drivers of MASLD. Graphical Abstract

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 90%

Factors associated with high costs of patients with metabolic dysfunction-associated steatotic liver disease: an observational study using the French CONSTANCES cohort

Ossima,

Brzustowski,

Paradis

et al. 2024

Clin Diabetes Endocrinol

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“…Second, because the CARDIA cohort recruited only Black and White participants, our results might not be generalizable to other racial and ethnic groups and populations with different sociodemographic characteristics, particularly those with the highest prevalence of NAFLD, such as Hispanic populations and those with low socioeconomic status . Future trials and population-based cohort studies should include proper representation of the populations that are most affected by NAFLD to help develop future guidelines that support equitable access to prevention and treatment of NAFLD for all patients . Third, our findings are unable to differentiate incident from prevalent NAFLD, as only a single assessment of NAFLD was evaluated.…”

Section: Discussionmentioning

confidence: 87%

Young Adult Physical Activity Trajectories and Midlife Nonalcoholic Fatty Liver Disease

de Brito,

McDonough,

Mathew

et al. 2023

JAMA Netw Open

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ImportancePhysical activity (PA) is recommended for preventing and treating nonalcoholic fatty liver disease (NAFLD). Yet, how long-term patterns of intensity-based physical activity, including moderate-intensity PA (MPA) and vigorous-intensity PA (VPA), might affect the prevalence of NAFLD in middle age remains unclear.ObjectiveTo identify distinct intensity-based PA trajectories from young to middle adulthood and examine the associations between PA trajectories and NAFLD prevalence in midlife.Design, Setting, and ParticipantsThis population-based cohort of 2833 participants used the Coronary Artery Risk Development in Young Adults study data. The setting included field clinics in Birmingham, Alabama; Chicago, Illinois; Minneapolis, Minnesota; and Oakland, California. Data analysis was completed in March 2023.ExposuresPA was self-reported at 8 examinations over 25 years (1985-1986 to 2010-2011) and separately scored for MPA and VPA.Main Outcomes and MeasuresNAFLD was defined as liver attenuation values less than 51 Hounsfield units after exclusion of other causes of liver fat, measured using computed tomography in year 25 (2010-2011).ResultsAmong a total of 2833 participants included in the sample, 1379 (48.7%) self-identified as Black, 1454 (51.3%) as White, 1206 (42.6%) as male, and 1627 (57.4%) as female from baseline (1985-1986) (mean [SD] age, 25.0 [3.6] years) to year 25 (2010-2011) (mean [SD] age, 50.1 [3.6] years). Three MPA trajectories were identified: very low stable (1514 participants [53.4%]), low increasing (1096 [38.7%]), and moderate increasing (223 [7.9%]); and 3 VPA trajectories: low stable (1649 [58.2%]), moderate decreasing (1015 [35.8%]), and high decreasing (169 [6.0%]). After adjustment for covariates (sex, age, race, study center, education, smoking status, and alcohol consumption), participants in the moderate decreasing (risk ratio [RR], 0.74; 95% CI, 0.54-0.85) and the high decreasing (RR, 0.59; 95% CI, 0.44-0.80) VPA trajectories had a lower risk of NAFLD in middle age, relative to participants in the low stable VPA trajectory. Adjustments for baseline body mass index and waist circumference attenuated these estimates, but the results remained statistically significant. The adjusted RRs across the MPA trajectories were close to null and not statistically significant.Conclusions and RelevanceThis cohort study of Black and White participants found a reduced risk of NAFLD in middle age for individuals with higher levels of VPA throughout young to middle adulthood compared with those with lower VPA levels. These results suggest the need for promoting sustainable and equitable prevention programs focused on VPA over the life course to aid in lowering NAFLD risk.

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“…A recent study has shown that within hepatology, ARLD has the poorest ratio between disease burden and published research activity and this has not improved over the last 10 years 51 . There is also a concerning dearth of research into the health inequalities experienced by people with ARLD 52 . In order to improve outcomes in ARLD, this must change.…”

Section: Discussionmentioning

confidence: 99%

“…51 There is also a concerning dearth of research into the health inequalities experienced by people with ARLD. 52 In order to improve outcomes in ARLD, this must change.…”

Section: Implications For Future Researchmentioning

confidence: 99%

Proactive case finding of alcohol‐related liver disease in high‐risk populations: A systematic review

Archer,

Phillips,

Subhani

et al. 2024

Liver International

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BackgroundAlcohol‐related liver disease (ARLD) is often diagnosed at a late stage when mortality is unacceptably high. Earlier identification of ARLD may lead to reduced alcohol intake, participation in hepatocellular carcinoma surveillance and reduction in liver‐related morbidity and mortality. People with alcohol use disorder (AUD) are at highest risk of ARLD. The aim of this systematic review was to understand the yield of proactive screening for ARLD amongst high‐risk groups.MethodsEmbase, Medline, Scopus and grey literature were searched for studies describing proactive assessment for alcohol‐related liver disease in people with a history of alcohol excess or diagnosed AUD. Outcomes of interest were fibrosis and cirrhosis detection rates, clinical outcomes, portal hypertension evaluation, attendance at follow‐up and cost‐effectiveness.ResultsFifteen studies were identified for inclusion from 1115 returned by the search. Four key settings for patient engagement were identified as inpatient addiction services, outpatient addiction services, general acute hospital admissions and community outreach. Of these, acute hospital admissions were the highest yield for cirrhosis at 10.8%–29.6% and community outreach the lowest was 1.2%–2.3%.ConclusionsTargeted fibrosis assessment of high‐risk populations for ARLD is feasible to conduct and identifies a proportion of patients at risk of advanced liver disease. The highest yield is amongst inpatients admitted with AUD. Prospective work is needed to establish which are the most effective and acceptable screening methods and the impact on long‐term outcomes.

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Applying an equity lens to liver health and research in Europe

Cited by 9 publications

References 45 publications

Factors associated with high costs of patients with metabolic dysfunction-associated steatotic liver disease: an observational study using the French CONSTANCES cohort

Factors associated with high costs of patients with metabolic dysfunction-associated steatotic liver disease: an observational study using the French CONSTANCES cohort

Young Adult Physical Activity Trajectories and Midlife Nonalcoholic Fatty Liver Disease

Proactive case finding of alcohol‐related liver disease in high‐risk populations: A systematic review

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